Exploring the relationships between health literacy, social support, self-efficacy and self-management in adults with multiple chronic diseases

Abstract

Background Self-management in chronic diseases is essential to slowing disease progression and preventing complications. However, empirical research on the associations of critical factors, such as health literacy, social support, and self-efficacy with self-management in the context of multiple chronic diseases is scarce. This study aimed to investigate these associations and provides insights for healthcare providers to develop effective educational strategies for people with multiple chronic diseases. Methods Using a cross-sectional survey design, adults (n = 600) diagnosed with at least two chronic diseases were conveniently recruited. To measure health literacy, social support, self-efficacy, and chronic disease self-management behaviours, the Health Literacy Questionnaire (HLQ), Medical Outcome Study - Social Support Survey, Self-efficacy in Managing Chronic Disease, and Self-management in Chronic Diseases instruments were utilized respectively. Comorbidity status was assessed using Age-adjusted Charlson Comorbidity Index (ACCI). A generalised linear regression model was used with a backward technique to identify variables associated with self-management. Results Participants’ mean age was 61 years (SD = 15.3), 46% were female, and most had up to 12 years of education (82.3%). Mean scores for HLQ domains 1–5 varied from 2.61 to 3.24 (possible score 1–4); domains 6–9 from 3.29 to 3.65 (possible score 1–5). The mean scores were 52.7 (SD = 10.4, possible score 0–95), 5.46 (SD = 1.9, possible score 0–10) and 82.1 (SD = 12.4, possible score 30–120) for social support, self-efficacy, and self-management, respectively. Mean ACCI was 6.7 (SD = 2.1). Eight factors (age > 65 years, being female, 4 health literacy domains, greater social support, and higher self-efficacy levels) were significantly associated with greater self-management behaviours while comorbidity status was not. The factors that showed the strongest associations with self-management were critical health literacy domains: appraisal of health information, social support for health, and healthcare provider support. Conclusions Developing critical health literacy abilities is a more effective way to enhance self-management behaviours than relying solely on self-confidence or social support, especially for people with multiple chronic diseases. By facilitating communication and patient education, healthcare providers can help patients improve their critical health literacy, which in turn can enhance their self-management behaviours.

Experiences and challenges of people living with multiple long-term conditions in managing their care in primary care settings in Kerala, India: A qualitative study

“…While patients with MLTCs reported receiving information on self-management, there appears to be a difficulty in tailoring this information for self-management practices due to the illness burden experienced. Our study findings are consistent with previous research that communicative and critical health literacy play substantive role than functional health literacy in fostering self-management behaviours in chronic conditions [ 56 , 57 ]. Health literacy is viewed as comprising three progressive skills: functional (reading and writing), communicative (cognitive and literacy skills for applying health information), and critical health literacy (the ability to analyze and use data for health decisions) [ 58 , 59 ] However, it is also crucial to recognize that the healthcare systems [ 60 ]can significantly mitigate the potential mismatch between low health literacy among patients and the system by providing personalized care, easily understandable communication, and tailored support.…”

“…Therefore, beyond health system support, those with MLTCs may benefit from a network of social relationships to manage their healthcare and lives. [ 56 , 61 ] Improved access to a social support network has been demonstrated to enhance mental health and treatment adherence [ 56 , 57 ] A recent study from Kerala highlighted the role of neighbourhood clinics in improving healthcare access and building social capital for older men and women in the areas they served. Operating under the name Vayomitram , these neighbourhood clinics were situated where many individuals aged 65 and above resided, offering preventive and curative primary care.…”

The Rising Challenge of Poor Health Literacy of Patients with Systemic Sclerosis: Preliminary Data Identify Important Unmet Needs in an Italian Cohort

“…However, it is also possible that more HL skills may not automatically translate to effective self-care behaviors. For example, well-educated people may have sufficient knowledge of how to deal with their health, but they do not perform important self-care practices, perhaps because of poor self-efficacy, poor social support, or other risk factors such as depression and low motivation [ 35 ]. Indeed, in their meta-analysis, Marciano et al (2022) suggest a positive and significant association between HL and self-care [ 36 ], yet in chronic conditions the nature and the direction of this relationship is not clear [ 37 ].…”

Health literacy and self-management among middle-aged and young hypertensive patients: a parallel mediation effect of illness perception and self-efficacy

“…Patients with a robust sense of self-efficacy are more inclined to engage in proactive self-management behaviors, such as regular blood pressure monitoring, adhering to prescribed medication regimens, and maintaining a healthy lifestyle. Consequently, enhancing health literacy and self-efficacy fosters improved self-management practices, ultimately contributing to more favorable health outcomes (Warren-Findlow et al, 2012;Dinh and Bonner, 2023). (2012), is a comprehensive model that delineates how individuals access, evaluate, and apply health information.…”